Teething is one of the significant milestones of an infant’s development. Memories of your baby’s first big toothy grin will stay cherished forever. Some babies hardly appear to have any trouble; for others, it can be a more uncomfortable time. Most babies will have grouchy and irritable periods.

Initial signs of teething usually show up a few months before the first tooth appears, and you can watch for the following 10 symptoms. While most parents generally agree these issues occurred around the time of teething, check with your pediatrician to rule out other possible causes – especially if your baby is running a fever or appears lethargic or sick.

1. Irritability

As the new tooth rises closer to the surface, your baby’s gums may become increasingly sore and painful, leading to fussiness and crying.

2. Drooling

From 3 to 4 months of age, you may see your baby start drooling more often than normal. Teething stimulates drooling, which may be worse with some babies than others.

3. Coughing

The increase in saliva can cause your baby to occasionally cough or gag. As long she shows no signs of a cold or flu and doesn’t run a high fever, this is nothing to worry about.

4. Chin rash

If your baby is a heavy drooler, the constant contact with saliva may cause the skin around the chin and mouth to become irritated. Gently wipe your baby’s mouth and chin periodically throughout the day to help prevent chapped skin and rashes.

5. Biting and gnawing

A teething baby will gnaw and gum-down on anything. The counter pressure from biting helps relieve the pressure from under the gums and temporarily numbs the pain. Teething aids designed specifically for babies are safe and effective.

6. Cheek rubbing and ear pulling

Pain in the gums may spread to the ears and cheeks, particularly when the back molars begin coming in. This is why you may see your baby rubbing his cheeks or pulling at his ears. However, keep in mind that pulling at an ear can also be a sign of an ear infection, especially when accompanied by a fever.

7. Diarrhea

Most parents notice slightly looser bowel movements when a baby is teething. A study the Children’s Hospital in Australia found this the most common symptom of teething, yet many doctors still disagree and discount this. The most likely cause of diarrhea during teething is extra saliva swallowed, which then loosens the stool. Report any diarrhea that lasts for more than three bowel movements to your doctor.

8. Low-grade fever

This is another sign doctors are sometimes hesitant to directly link with teething. Many parents, however, find their babies get low-grade fevers while teething. Notify your doctor if the temperature rises above 102 degrees F, or if the temperature remains elevated for more than two days.

You may find your child wakes more often at night. Most parents agree that babies often awake more frequently when the molars are coming in.

10. Cold-like symptoms

Some find that their babies get runny noses or start to cough. This is believed to be a result of frequent hand-to-mouth movements in an attempt to alleviate pain. Notify your doctor if these symptoms occur for more than three days and don’t improve on their own.

Teething frequently follows hereditary patterns, so if mom or dad teethed early or late, your baby may follow suit. On average, the first tooth comes in when a baby is 7 months, although it can arrive as early as 3 months, as late as a year – or, in rare cases, even earlier or later.

Thumb-sucking can be a precursor to teething, but if it continues past toddler age and you’re concerned, read this.